Washington seniors face denied, delayed care under AI Medicare review program
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Developing: a major or severe case captured in the last 72 hours. Later changes are logged on the corrections page.
Status: no action reported
No source states: loss or records, developer and model, agent tool, could do, deployer, industry.
Severity major: Test: many third parties with a stated count of two or more affected parties. Fact: representatives from 16 Washington hospitals reported patients waiting two to four times longer.
A federal pilot program called WISeR uses AI to review prior-authorization requests for certain Medicare procedures in Washington and five other states. The vendor chosen to run the program in Washington is Virtix Health. Hospital representatives reported that patients now wait two to four times longer for authorizations, and University of Washington Medicine reported approvals rising from one to three days to 15 to 20 days. Physicians questioned whether the required medical review of AI-driven denials was taking place. Virtix acknowledged procedural problems in the first months and called them a natural part of the process. Democratic lawmakers appealed to the Government Accountability Office, which agreed on May 12, and repeal measures were then introduced in both chambers.
What happened
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What was done
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Controls
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Similar incidents
Evidence
- Other parties affected 16
No source states: a step-by-step account, when it happened, when it was found, how many records were exposed, the direct loss, any court case, the cause, what set it off, what was done.
Show the full account: 4 items from the primary sources
What happened, in order
- January WISeR launched in Washington and five other states.
- last October American Heart Association urged the government to delay WISeR implementation in a report.
Not dated in the sources:
- Reporting describes the pilot as five months in, with new hurdles and worsening outcomes.
- Virtix held a webinar with Washington state physicians.
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The AI system
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Impact
Notes on gaps
No risk or control was assigned because the sources do not state which controls held, failed or were missing; the physician doubts about human review are reported as doubts.
LR-2026-0543 · version 1 · published 2026-11-01 after automatic checks; not yet checked field by field by a person · JSON